Diabetes

by Bianca Arsenault

Diabetes


  • is a metabolic disease where the body's unable to produce any or enough insulin causing elevated levels of glucose in the blood.


  • Gestational diabetes (GDM) is caused by improper insulin responses, usually due from the hormones in placenta blocking mother's sensitivity to insulin causing insulin resistance.
    • poorly controlled GDM can hurt the baby, causing baby's pancreas to produce more insulin than needed, which in turn stores as fat instead of energy and can cause many complication once born & while in womb.


  • T1D/Insulin-dependent is a chronic condition where the pancreas produces little or no insulin.

  • T2D/Adult-onset is a chronic condition that affects the way your body metabolizes glucose. Your body either resists the effects of insulin or doesn't produce enough to maintain normal glucose levels.

Epidemiology

  • One of the first diseases described with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."


  • Indian doctors classified it as honey urine noting that the urine would attract ants from the sweetness.


  • According to the ADA in 2012, 9.3%~29.1 million Americans had diabetes; 1.25 million people being Type 1 Diabetes.


  • Approximately 1.4 million Americans are diagnosed with diabetes each year


  • In the early 2000s, diabetes with the fifth cause of death in the country

Pathophysiology

  • Diabetes occurs when there's a dis-balance between demand and production of insulin.

  • Type 1:
    • immune system attacks & destroys insulin producing beta cells; leading to beta cell deficiency; leading to complete insulin deficiency
    • termed an autoimmune disease; there are anti-insulin/islet cell antibodies present in the blood
    • destruction may take time but the onset of the disease itself is rapid
    • T1D always requires insulin therapy; no response to oral insulin-stimulating drugs


  • Type 2:
    • body is unable to produce adequate insulin to meet the body's needs
    • there is a beta cell deficiency with peripheral insulin resistance (meaning blood levels of insulin are high but no hypoglycemia)
    • this may be due to changes in insulin receptors
    • obesity is a main cause of insulin resistance
    • if/when oral insulin-stimulating drugs fail, injections will be necessary

Diagnosis


  • Diabetes may be diagnosed on A1C criteria or plasma glucose criteria
  • A1C is essentially an average of the patient's blood sugar levels for the previous 3 months and could be an indicator something isn't right if it is an elevated number
  • Fasting plasma glucose (FPG) or 2-hr plasma glucose (2-h PG) after a 75-g oral glucose tolerance test (OGTT)
  • Diabetes may be identified along spectrum of clinical scenarios; seemingly low-risk people who happen to have glucose testing, in symptomatic patients and in higher-risk people where the doctor tests due to suspicious symptoms of diabetes

Treatment

  • Type 1: maintaining normal blood sugar levels through regular glucose monitoring, insulin therapy, diet & exercise

  • Type 2: Diet, exercise, medication & insulin therapy

  • Gestational: Daily glucose monitoring, healthy diet, exercise & monitoring the baby. If blood sugars run too high medications will be needed.

Follow-Up

  • A comprehensive physical once a year with PCP
  • At least every 6 months must see an endocrinologist
  • Eye exam once a year
  • Any complications that arise will be assessed and doctor visit plans will be made

( I.E., cardiovascular problems, kidneys, nerve damage, abnormal hormone levels)

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Public - 4/20/16, 4:51 AM